RULES OF THE OPERATING ROOM

[For medical students] I recently gave the new group of med students their OB/GYN rotation orientation. It wasn't so long ago that I was in their shoes--nervous, eager to please, and unsure of what I didn't know. This is a compilation of what I was taught and what I've picked up along the way.

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Don't contaminate ANYTHING.

Don't touch the operating field or the instrument table with anything but your sterile glove or gown. FYI- the areas below your waist, above your chest, armpits, and your back is considered NOT sterile even though you put on a sterile gown. If you don't know what to do with your hands, hold them clasped against your upper abdomen. I will not be happy if I have to open a new instrument or put on a sterile sleeve because you contaminated it.

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Never say "Oops".

Especially during C-sections when the patients are awake! One of my attendings used to say "There" and point to what was worrisome.

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Don't ask questions when the patient is hemorrhaging.

Some med students who are eager to impress ask questions that show they've read up. Generally, this is great! But when the blood is welling up or an arterial pumper is squirting blood out the body, the surgeons need to concentrate and the scrub tech needs to hear what instruments are needed. If you're still talking at a time like that, you aren't paying attention to the case.

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Know your anatomy.

Expect to get "pimped" (pop-quizzed) on anatomy. If you don't know the anatomy, you shouldn't be operating.

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Don't take any instruments off the Mayo Stand without asking.

The Mayo Stand is a sterile instrument tray positioned close to the operating field. The scrub tech will not hesitate to chastise you if you grab something without asking. It's not a power play thing. It's a safety thing. Instruments have to be accounted for and placed in a way that minimizes accidental injury. Also, med students shouldn't call for any instruments except the suture scissors.

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Err on the side of cutting the sutures too long vs. too short.

The resident ties the suture knot, then holds up the two strings, points to you, and says, "Cut." But she doesn't specify how long of a tail she wants. You'll feel like you can never get it right. When in doubt, cut the suture strings on the longer side. Long strings can always be trimmed closer to the knot. Strings that are too short make the attending worry the stitch may come undone. No Bueno.

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Don't move the light when the surgeon is cutting something.

Obvs.

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The attending gets gowned first.

Then the senior resident, then the junior resident, then the med student. This is an unspoken rule, but one that most observant students seem to pick up on their own. Unless you're specifically told by the attending to get gowned first, you should stand back with your wet hands in the air trying not to contaminate anything until it's your turn.

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Wear a surgical cap and face mask.

Tuck all your wispy strands of hair up in the cap. If the nurse and scrub tech point out that you're looking sloppy, thank them! You don't want your resident or attending to be the ones to do so. (BTW, it drives me crazy when TV doctors don't wear masks in the OR!)

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If you've got a beard, congratulations--you get to wear this. ➡️

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Introduce yourself to everyone.

You're a stranger to the OR staff. Be friendly and introduce yourself! Get your own gown and gloves out for them. Appreciate any tips they give you (where to stand, what to watch out for, how to be helpful) because it will only make you look better to the attending and resident. Trust me--when a scrub tech or nurse likes a med student, they will tell the attending.

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Don't talk about how tired you are.

You're not as tired as the resident or the attending.

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Don't make too many jokes.

It's cool if a med student has a sense of humor! However, surgery is serious business. Even if the attending or resident cracks some jokes, don't forget you're in the OR operating on a person. Also, there's something about a student getting *too* comfortable with me that rubs me the wrong way.

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Be a helpful part of the team.

Sorry, but you're at the bottom of the totem pole in the OR. Mostly because you don't even know what to do. So, ask! You can always get the bed from the hallway or warm blankets for the patient after the surgery. The more helpful things you do, the more it shows that you're paying attention to the process. Students who do this are often rewarded by getting to do more than just cutting sutures intra-op. 🌟